Successful treatment of rheumatoid vasculitis-associated cutaneous ulcers using rituximab in two patients with rheumatoid arthritis

Sir, The course of RA may be complicated by rheumatoid vasculitis (RV), at least in a subset of patients who typically present with high titres of RFs [1]. RV has a predilection for the skin and may result in peripheral gangrene and deep cutaneous ulcers that tend to occur in unusual locations. Treatment mainly consists of the use of high-dose corticosteroids in addition to DMARDs, but controlled clinical trials are missing [2]. More recently, the successful use of TNF inhibitors in selected patients has been reported [3]. The use of rituximab (RTX), a monoclonal antibody that selectively targets CD20+ B cells, has resulted in significant improvement of articular symptoms in patients with active RA [4, 5] and is currently licenced for patients previously failing a TNF inhibitor. Small series and case reports have been published suggesting that RTX may be effective in ANCA-associated vasculitis and cryoglobulinaemia [6, 7]. However, the efficacy of RTX in patients with severe RV is largely unknown.